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Japanese Journal of Clinical Oncology 30:122-125 (2000)
© 2000 Foundation for Promotion of Cancer Research

Successful Initial Treatment with Weekly Etoposide, Epirubicin, Cisplatin, 5-Fluorouracil and Leucovorin Chemotherapy in Advanced Gastric Cancer Patients with Disseminated Intravascular Coagulation

Yee Chao1,4,+, Ho-Chung Teng2, Hung-Chang Hung2,4, Kuang-Liang King3,4, Chung-Pin Li2,4, Kwan-Hwa Chi1,4, Sang-Hue Yen1,4 and Full-Young Chang2,4

1Cancer Center, Division of Gastroenterology, 2Department of Medicine, Division of General Surgery and 3Department of Surgery, Veterans General Hospital–Taipei, Taipei and 4National Yang-Ming University, School of Medicine, Taipei, Taiwan

Background: Acute disseminated intravascular coagulation (DIC) is a rare but severe complication of gastric adenocarcinoma. Conventional treatments, such as fresh frozen plasma, platelet replacement and heparin injections, are disappointing. The only way to correct this fatal condition is to control the underlying cancer promptly by effective chemotherapy. Here the successful initial control of acute DIC in gastric cancer patients with weekly EEPFL chemotherapy is reported.

Methods: Advanced gastric cancer patients complicated with acute DIC were eligible. Patients were treated with weekly EEPFL therapy (etoposide 40, epirubicin 10, cisplatin 25, 5-fluorouracil 2200 and leucovorin 120 mg/m2 ). Response, survival and toxicity were evaluated.

Results: From April 1997 to April 1999, six patients were included in this study. All patients received EEPFL chemotherapy. Clinical and laboratory evidence of acute DIC stabilized quickly after starting chemotherapy. Four patients showed a partial response, one stable disease and one progressive disease. The toxicity was mild and well tolerated. Median survival was 28 weeks (12, 14, 26, 30, 30 and 32 weeks). All patients suffered from a relapse of DIC after initial successful control and died within 30 days of clinical and laboratory evidence of acute DIC relapse.

Conclusion: EEPFL therapy is an effective chemotherapy regimen for patients with advanced gastric cancer associated with acute DIC. The prognosis is poor if the DIC relapses after the initial successful control.

+ For reprints and all correspondence: Yee Chao, Cancer Center, Veterans General Hospital–Taipei, No 201, Section 2, Shih-Pai road, Taipei, 112, Taiwan. E-mail: chaoy@vghtpe.gov.tw


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